Global epidemiology of early-onset liver cancer attributable to specific aetiologies and risk factors from 2010 to 2019

Background Considering its emergence as a public health concern worldwide, with potential spatial-temporal heterogeneities, we aimed to determine the global burden of early-onset liver cancer attributable to aetiologies and concomitant risk factors. Methods We used data from the Global Burden of Diseases Study 2019 to determine age-standardised disability-adjusted life-year (DALY) rates for early-onset liver cancer by aetiologies and the population DALYs attributable to concomitant risk factors between 2010 and 2019. We also calculated estimated annual percentage changes (EAPCs) to measure temporal trends. Results There were 2.9 million DALYs related to early-onset liver cancer globally in 2019. East Asia contributed over half of DALYs, which increased annually by 1.23% (95% confidence interval (CI) = 0.71, 1.76) between 2010 and 2019. Non-alcoholic steatohepatitis was the only growing aetiology. The proportion of DALYs attributed to metabolic risks increased by 22.50% (95% CI = 14.33, 38.13), while behavioral risks remained stable. Obesity surpassed smoking as the most prevalent nondeterministic aetiological risk factor from 2010 to 2019, while the population DALY attributable to hepatitis B combined with obesity increased by 29.93% (95% CI = 8.49, 60.77) in the same period, making it the principal joint contributor. Conclusions Early-onset liver cancer poses considerable disability and continues to increase in many regions, especially in East Asia. Metabolic risk factors, particularly when hepatitis B and obesity coexist, are the fastest-growing contributors to this type of cancer. More targeted interventions are imperative to curb the growing burden of early-onset liver cancer due to metabolic risks.


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Figure S4.(A) Proportional DALY burden of early-onset liver cancer etiology.(B) Proportional DALY burden of early-onset liver cancer etiology by SDI regions......

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Figure S5.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to hepatitis B in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by hepatitis B from 2010 to 2019..............

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Figure S6.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to hepatitis C in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by hepatitis C from 2010 to 2019..............

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Figure S7.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to alcohol use in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by alcohol use from 2010 to 2019.............

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Figure S9.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to other causes in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by other causes from 2010 to 2019 ...........

Figure S2 .
Figure S2.The EAPC (A) and longitudinal patterns (B) of six trajectory groups for the agestandardized early-onset liver cancer DALY rates over time.EAPC=estimated annual percentage change.DALY=disability-adjusted life-year.

Figure S3 .
Figure S3.The correlation between EAPC and HDI in 2019 The circles represent countries that were available on HDI data.The size of circle is increased with the cases of early-onset liver cancer.The stratified Pearson correlation coefficient (ρ) and P values were presented.EAPC=estimated annual percentage change.DALY=disabilityadjusted life-year.HDI=human development index.

Figure S5 .
Figure S5.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to hepatitis B in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by hepatitis B from 2010 to 2019.DALY=disability adjusted life-year.EAPC=estimated annual percentage change.

Figure S6 .
Figure S6.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to hepatitis C in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by hepatitis C from 2010 to 2019.DALY=disability adjusted life-year.EAPC=estimated annual percentage change.

Figure S7 .
Figure S7.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to alcohol use in 2019.(B) The EAPC of the age-standardized DALY rates of earlyonset liver cancer caused by alcohol use from 2010 to 2019.DALY=disability adjusted lifeyear.EAPC=estimated annual percentage change.

Figure S8 .
Figure S8.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to NASH in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by NASH from 2010 to 2019.DALY=disability adjusted life-year.EAPC=estimated annual percentage change.

Figure S9 .
Figure S9.(A) The age standardized DALY rates (per 100,000) of early-onset liver cancer due to other causes in 2019.(B) The EAPC of the age-standardized DALY rates of early-onset liver cancer caused by other causes from 2010 to 2019.DALY=disability adjusted life-year.EAPC=estimated annual percentage change.

Figure S10 .
Figure S10.Proportion of DALYs attributable to concomitant risk factors by etiology type of early-onset liver cancer, in 2010 and 2019 for both sexes combined DALY=disability-adjusted life-year.LCHBV=early-onset liver cancer due to hepatitis B. LCHCV=early-onset liver cancer due to hepatitis C. LCAL=early-onset liver cancer due to alcohol consumption.LCNASH=early-onset liver cancer due to NASH.LCOT=early-onset liver cancer due to other causes.

Figure S11 .
Figure S11.Age-standardized population-attributable fraction of DALYs of early-onset liver cancer attributable to the risk clusters and concomitant risk factors, for both sexes, 2019

Table S1 .
The DALYs and DALY rates of early-onset liver cancer in 2010 and 2019, and its temporal trends from 2010 to 2019

Table S2 .
Age-standardized DALY rates of early-onset liver cancer in 2010 and 2019, and its temporal trends 2010 to 2019, and the risk classification identified by the group-based trajectory model DALY=disability adjusted life-year.CI=confidence interval.